{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:27:17Z","timestamp":1786688837999,"version":"build-2736575974"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly used in children with pancreaticobiliary diseases. Although pediatric ERCP is feasible in experienced centers, perioperative adverse events, delayed recognition of early warning signs, and drainage-related problems remain important safety concerns. This study evaluated the real-world implementation of a risk-stratified perioperative safety pathway in children undergoing elective ERCP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective historical cohort study included consecutive children who underwent elective ERCP at Anhui Provincial Children's Hospital between June 2022 and December 2025. Children treated from June 2022 to June 2023 received routine perioperative management, whereas those treated from July 2023 to December 2025 were managed under a risk-stratified perioperative safety pathway. The pathway incorporated structured preoperative risk assessment, procedure-related handover, early warning-based postoperative monitoring, standardized nasobiliary drainage management, and family-centered perioperative education. The primary outcome was the proportion of children who experienced at least one prespecified in-hospital perioperative adverse event. Secondary outcomes included postoperative recovery indicators and caregiver-reported care experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 63 children were included, with 30 in the routine management group and 33 in the risk-stratified pathway group. Baseline demographic and disease characteristics were comparable between groups. Compared with routine management, the pathway group had a shorter time to first flatus (20.3\u2009\u00b1\u20095.1 vs. 27.5\u2009\u00b1\u20096.2\u2005h,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01), earlier resumption of oral intake (33.6\u2009\u00b1\u20097.9 vs. 44.2\u2009\u00b1\u20098.7\u2005h,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01), and a shorter length of hospital stay (5.2\u2009\u00b1\u20091.8 vs. 7.5\u2009\u00b1\u20092.1 days,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). The proportion of children with at least one in-hospital perioperative adverse event was lower in the pathway group than in the routine management group (24.2% vs. 53.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.017). Nasobiliary drainage-related complications were less frequently observed in the pathway group (6.1% vs. 23.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.046).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center retrospective historical cohort, implementation of a risk-stratified perioperative safety pathway was associated with faster postoperative recovery, fewer in-hospital perioperative adverse events, and better caregiver-reported care experience. Exploratory findings for individual adverse-event components, including nasobiliary drainage-related complications, should be interpreted cautiously because of the small sample size, multiple comparisons, and potential temporal confounding. Prospective multicenter studies are needed to validate these associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1900187","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:33:24Z","timestamp":1786685604000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of a risk-stratified perioperative safety pathway for children undergoing elective ERCP: a single-center real-world retrospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Tian-Hang","family":"Wu","sequence":"first","affiliation":[{"name":"Department of General Surgery, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Xia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Qin","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Anhui Provincial Children\u2019s Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1111\/den.13928","article-title":"Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children","volume":"33","author":"Tagawa","year":"2021","journal-title":"Dig Endosc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jpeds.2016.08.046","article-title":"Complications of endoscopic retrograde cholangiopancreatography in pediatric patients: a systematic literature review and meta-analysis","volume":"179","author":"Usatin","year":"2016","journal-title":"J Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1186\/s12887-023-04392-5","article-title":"Indications, success, and adverse event rates of pediatric endoscopic retrograde cholangiopancreatography (ERCP): a systematic review and meta-analysis","volume":"23","author":"Hosseini","year":"2023","journal-title":"BMC Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/MPG.0000000000003875","article-title":"Pediatric ERCP: factors for success and complication\u2014a 17-year, multisite experience","volume":"77","author":"Lorio","year":"2023","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.gie.2008.10.039","article-title":"Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years","volume":"70","author":"Cotton","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/j.1572-0241.2006.00380.x","article-title":"Risk factors for post-ERCP pancreatitis: a prospective multicenter study","volume":"101","author":"Cheng","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2272","DOI":"10.4240\/wjgs.v15.i10.2272","article-title":"Endoscopic retrograde cholangiopancreatography for diagnosing and treating pediatric biliary and pancreatic diseases","volume":"15","author":"Qin","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.gie.2022.10.005","article-title":"American Society for gastrointestinal endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations","volume":"97","author":"Buxbaum","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: european society of gastrointestinal endoscopy (ESGE) guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"B10","doi-asserted-by":"publisher","first-page":"100262","DOI":"10.1016\/j.resplu.2022.100262","article-title":"Do paediatric early warning systems reduce mortality and critical deterioration events among children? 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